Johan Flamaing

Introduction: Older adults living at home increasingly face mood disorders alongside multimorbidity, yet healthcare remains fragmented. Gaps in coordination, limited integration of mental and physical health services, and insufficient multidisciplinary collaboration persist. To address these challenges, we developed I-CONNECT, a structured, stakeholder-informed, integrated care model. The aim of this paper is to describe the systematic development of I-CONNECT and its alignment with evidence-based practices and feasibility within the Belgian healthcare system. Methods: We followed a pragmatic, mixed-methods approach guided by ten recommended actions for intervention development. The process involved a scoping review, qualitative research with healthcare providers, patients, and caregivers, and a series of stakeholder workshops and meetings to iteratively design and refine the intervention and inform its feasibility. A logic model articulated the program theory, and the intervention was described using the TIDieR framework. Results: The process resulted in I-CONNECT, a prototype integrated care model for home-dwelling older adults with mood disorders and multimorbidity. The model builds on existing healthcare structures and on six key principles: personalized care, care coordination, self-management support, multidisciplinary collaboration, medication reviews, and follow-ups. These were translated into a six-step care process. Conclusion: I-CONNECT is a pragmatic, evidence-informed model addressing systemic fragmentation in Belgian healthcare. A forthcoming evaluation will refine the model and inform broader integrated care initiatives.

Pneumococcal infections caused by Streptococcus pneumoniae remain a leading cause of vaccine-preventable morbidity and mortality worldwide, particularly among older adults and individuals with immu...

Poorly executed care transitions from hospital to home can result in adverse outcomes, such as incorrect treatments, medication errors, patient dissatisfaction, rehospitalization, emergency department visits, and mortality. Integrated care services may improve the quality of these transitions, particularly for older, chronically ill patients who frequently move between care settings. This study aimed to (1) assess health-related quality of life (HRQoL) and older patients’ experiences during transitional care i and (2) compare these outcomes between patients residing within and outside an integrated care region in Belgium. This cross-sectional survey study was part of the European TRANS-SENIOR project. Participants included patients aged 65 and older who were discharged home from one of six acute hospital wards at University Hospitals Leuven, Belgium. HRQoL was measured using the EQ-5D-5 L and a Visual Analogue Scale (0–100). Patient experiences were assessed using the ‘Experiences with Hospital Care, Admission and Discharge’ instrument. Descriptive statistics were applied to the full sample, and comparative analyses were conducted between patients living inside versus outside an integrated care region. Statistical significance was set at p < 0.05. A total of 119 questionnaires were completed. The mean age of participants was 81 years, and 54.2% were female. Over 70% reported issues with mobility, pain/discomfort, daily activities, and self-care. Patients reported high scores for the patient experience dimensions hospital accessibility, hospital safety and care received by physicians and nurses. However, lower scores were noted for treatment communication, admission conversations and hospital discharge processes. No statistically significant differences were found in HRQoL or most patient experience dimensions between those living within versus outside an integrated care region. This survey highlights areas for improvement in transitional care. This information can support hospitals and health care professionals in refining discharge, transfer and postdischarge processes for older patients with chronic conditions.

Background/Objectives: Accurate assessment of physical activity is essential in hospital settings, but difficult for geriatric rehabilitation patients who have slow walking speed and rely on walking aids. This study conducted an external validation of the MOX activity monitor accuracy in distinguishing between sedentary (lying, sitting), standing, and dynamic activities among hospitalized geriatric rehabilitation patients. Additionally, the study assessed clinical tolerance and ease of use of the monitor. Methods: Inclusion criteria were being hospitalized on the geriatric rehabilitation ward, aged 70 years or older, and using a walking aid. The monitor was placed on the upper leg, and remained in place for 1 week. In a test-session, four activities of 4 min each (lying, sitting, standing, and walking) were filmed. Video analyses created a direct observation timeline. Daily skin irritation assessments were conducted and participants noted their discomfort level at the week’s end. Results: The study included 20 participants who relied on walking aids, with 10 requiring additional physical support while walking. The MOX activity monitor exhibited excellent accuracy in classifying the four activities, with a zero mean percentage error for sedentary activity, 2.2% for standing, and 2.7% for walking. Participants reported minimal hindrance, and the monitor proved user-friendly. Conclusion: The MOX activity monitor demonstrated remarkable accuracy in distinguishing between these four activities in a test-session and displayed strong clinical applicability. Significance: The monitor shows substantial promise as a valuable tool for assessing physical activity in hospitalized geriatric rehabilitation patients using walking aids.

Introduction Older adults face a higher risk of vancomycin-related toxicity given their (patho)-physiological changes, making early management of supratherapeutic exposure crucial. Yet, data on vancomycin exposure in older adults is scarce. This study aims to compare vancomycin concentrations between older and younger patients, emphasizing supratherapeutic concentrations and the effect of patient characteristics. Methods This observational retrospective study was conducted in the University Hospital of Leuven (EC Research S65213). We analyzed early (first) vancomycin concentrations between older (≥ 75 years) and younger patients. Multivariable analyses were conducted to evaluate the association between baseline patient characteristics with supratherapeutic exposure (logistic regression), and dose-normalized concentrations (linear regression). Results We included 449 patients aged ≥ 75 years (median 80) and 1609 aged < 75 years (median 61). In univariable analysis, the first-measured vancomycin concentrations were significantly higher in older adults (p < 0.001), who more frequently reached supratherapeutic concentrations (30.7% versus 21%; p < 0.001). In multivariable analysis, factors associated with supratherapeutic concentrations were decreased the estimated glomerular filtration rate calculated by using the Chronic Kidney Disease Epidemiology Collaboration equation (eGFR_CKD-EPI) [odds ratio (OR) of 0.98, confidence interval (CI) 0.97–0.98]. Supratherapeutic concentrations had inverse association with giving lower loading dose (OR of 0.59, CI 0.39–0.90), and lower maintenance dose (OR of 0.45, CI 0.26–0.77). Factors that predicted increased dose-normalized concentrations included decreased eGFR_CKD-EPI (coefficient of −0.05, CI −0.06 to −0.04), lower body weight (coefficient of −0.04, CI −0.05 to −0.03), increased blood urea nitrogen (coefficient of 0.02, CI 0.01–0.03), and delayed time to therapeutic drug monitoring (TDM) sampling (coefficient of 0.08, CI 0.06–0.09). Conclusions The absence of age as a significant factor in the multivariable analysis suggests that eGFR_CKD-EPI mediated the relationship between age and vancomycin exposure. Older adults may benefit more from vancomycin TDM.

This study aims to describe end-of-life (EOL) care in older patients with cancer and investigate the association between geriatric assessment (GA) results and specialized palliative care (SPC) use. Older patients with a new cancer diagnosis (2009–2015) originally included in a previous multicentric study were selected if they died before the end of follow-up (2019). At the time of cancer diagnosis, patients underwent geriatric screening with Geriatric 8 (G8) followed by GA in case of a G8 score ≤14/17. These data were linked to the cancer registry and healthcare reimbursement data for follow-up. EOL care was assessed in the last three months before death, and associations were analyzed using logistic regression. A total of 3546 deceased older patients with cancer with a median age of 79 years at diagnosis were included. Breast, colon, and lung cancer were the most common diagnoses. In the last three months of life, 76.3% were hospitalized, 49.1% had an emergency department visit, and 43.5% received SPC. In total, 55.0% died in the hospital (38.5% in a non-palliative care unit and 16.4% in a palliative care unit). In multivariable analyses, functional and cognitive impairment at cancer diagnosis was associated with less SPC. Further research on optimizing EOL healthcare utilization and broadening access to SPC is needed.

Summary The goal was to investigate if patient characteristics can be used to predict 1-year post-fracture mortality after proximal humeral fracture (PHF). A clinical prediction model showed that the combination of 6 pre-fracture characteristics demonstrated good predictive properties for mortality within 1 year of PHF. Introduction Proximal humeral fractures (PFH) are the third most common major non-vertebral osteoporotic fractures in older persons and result in an increased mortality risk. The aim of this study was to investigate if patient characteristics can be used to predict 1-year post-fracture mortality. Methods Retrospective study with 261 patients aged 65 and older who were treated for a PHF in University Hospitals Leuven between 2016 and 2018. Baseline variables including demographics, residential status, and comorbidities were collected. The primary outcome was 1-year mortality. A clinical prediction model was developed using LASSO regression and validated using split sample and bootstrapping methods. The discrimination and calibration were evaluated. Results Twenty-seven (10.3%) participants died within 1-year post-PHF. Pre-fracture independent ambulation (p < 0.001), living at home at time of fracture (p < 0.001), younger age (p = 0.006), higher BMI (p = 0.012), female gender (p = 0.014), and low number of comorbidities (p < 0.001) were predictors for 1-year survival. LASSO regression identified 6 stable predictors for a prediction model: age, gender, Charlson comorbidity score, BMI, cognitive impairment, and pre-fracture nursing home residency. The discrimination was 0.891 (95% CI, 0.833 to 0.949) in the training sample, 0.878 (0.792 to 0.963) in the validation sample and 0.756 (0.636 to 0.876) in the bootstrapping samples. A similar performance was observed for patients with and without surgery. The developed model demonstrated good calibration. Conclusions The combination of 6 pre-fracture characteristics demonstrated good predictive properties for mortality within 1 year of PHF. These findings can guide PHF treatment decisions.

Background: The acquisition of geriatric-friendly resources is an important part of adapting emergency department (ED) care to the needs of vulnerable older patients. The aim of this study was to explore the availability of geriatric-friendly protocols, equipment and physical environment criteria in EDs and to identify related improvement opportunities. Methods: The head nurse of 63 EDs in Flanders and Brussels Capital Region was invited to complete a survey in collaboration with the chief physician of the ED. The questionnaire was inspired by the American College of Emergency Physicians Geriatric ED Accreditation Program and explored the availability, relevance and feasibility of geriatric-friendly protocols, equipment and physical environment. Descriptive analyses were performed. A region-wide improvement opportunity was defined as a resource that was never to occasionally (0–50%) available on Flemish EDs and was scored (rather or very) relevant by at least 75% of respondents. Results: A total of 32 questionnaires were analysed. The response rate was 50.8%. All surveyed resources were available in at least one ED. Eighteen out of 52 resources (34.6%) were available in more than half of EDs. Ten region-wide improvement opportunities were identified. These comprised seven protocols and three physical environment characteristics: 1) a geriatric approach initiated from physical triage, 2) elder abuse, 3) discharge to residential facility, 4) frequent geriatric pathologies, 5) access to geriatric specific follow-up clinics, 6) medication reconciliation, 7) minimising ‘nihil per os’ designation, 8) a large-face, analogue clock in each patient room, 9) raised toilet seats and 10) non-slip floors. Conclusions: Currently available resources supporting optimal ED care for older patients in Flanders are very heterogeneous. Researchers, clinicians and policy makers need to define which geriatric-friendly protocols, equipment and physical environment criteria should become region-wide minimum operational standards. Findings of this study are relevant to facilitate the development process of this endeavour.